Healthcare Provider Details

I. General information

NPI: 1407924087
Provider Name (Legal Business Name): MR. RYAN WAYNE CUEVAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1299 BRYANT AVE
MOUNTAIN VIEW CA
94040-4527
US

IV. Provider business mailing address

201 ALMOND AVE
LOS ALTOS CA
94022-2206
US

V. Phone/Fax

Practice location:
  • Phone: 650-960-8839
  • Fax:
Mailing address:
  • Phone: 650-960-8839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number51322
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: